| NPI | 1437405503 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: CO 00204997) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MO 2017017285) |
| 124Q00000X Dental Hygienist (Licence: NM DH3361) | |
| Enumeration Date | 2012-07-26 |
| Last Update Date | 2022-06-15 |